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. 2017 Nov 28:10:52.
doi: 10.1186/s13047-017-0234-1. eCollection 2017.

Reliability of analysis of the bone mineral density of the second and fifth metatarsals using dual-energy x-ray absorptiometry (DXA)

N Stewart Pritchard  1 , James M Smoliga  1 , Anh-Dung Nguyen  2 , Micah C Branscomb  1 , David R Sinacore  3 , Jeffrey B Taylor  1 , Kevin R Ford  1
Affiliations

Reliability of analysis of the bone mineral density of the second and fifth metatarsals using dual-energy x-ray absorptiometry (DXA)

N Stewart Pritchard et al. J Foot Ankle Res. .

Abstract

Background: Metatarsal fractures, especially of the fifth metatarsal, are common injuries of the foot in a young athletic population, but the risk factors for this injury are not well understood. Dual-energy x-ray absorptiometry (DXA) provides reliable measures of regional bone mineral density to predict fracture risk in the hip and lumbar spine. Recently, sub-regional metatarsal reliability was established in fresh cadaveric specimens and associated with ultimate fracture force. The purpose of this study was to assess the reliability of DXA bone mineral density measurements of sub-regions of the second and fifth metatarsals in a young, active population.

Methods: Thirty two recreationally active individuals participated in the study, and the bone density of the second (2MT) and fifth (5MT) metatarsals of each subject was measured using a Hologic QDR x-ray bone densitometer. Scans were analyzed separately by two raters, and regional bone mineral density, bone mineral content, and area measurements were calculated for the proximal, shaft, and distal regions of the bone. Intra-rater, inter-rater, and scan-rescan reliability were then determined for each region.

Results: Proximal and shaft bone mineral density measurements of the second and fifth metatarsal were reliable. ICC's were variable across regions and metatarsals, with the distal region being the poorest.

Conclusions: Bone mineral density measurements of the metatarsals may be a better indicator of fracture risk of the metatarsals than whole body measurements. A reliable method for measuring the regional bone mineral densities of the metatarsals was found. However, inter-rater reliability and scan-rescan reliability for the distal regions were poor. Future research should examine the relationship between DXA bone mineral density measurements and fracture risk at the metatarsals.

Keywords: Bone health; Bone mineral density; Dual x-ray absorptiometry; Foot; Metatarsals; Stress fracture.

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Conflict of interest statement

Authors’ information

Not applicable

Ethics approval and consent to participate

Participants signed a consent form to participate in the research study that was approved by High Point University IRB.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Representative example of DXA analysis of the regions of interest from the lateral and medial scans. The outlined area within L2 was considered proximal. The outlined area within L3 was considered the shaft. The outlined area within L4 was considered distal
See this image and copyright information in PMC

References

    1. Iwamoto J, Sato Y, Takeda T, Matsumoto H. Analysis of stress fractures in athletes based on our clinical experience. World J Orthop. 2011;2:7–12. doi: 10.5312/wjo.v2.i1.7. - DOI - PMC - PubMed
    1. Zwitser EW, Breederveld RS. Fractures of the fifth metatarsal; diagnosis and treatment. Injury. 2010;41:555–562. doi: 10.1016/j.injury.2009.05.035. - DOI - PubMed
    1. Torg JS, Balduini FC, Zelko RR, Pavlov H, Peff TC, Das M. Fractures of the base of the fifth metatarsal distal to the tuberosity. Classification and guidelines for non-surgical and surgical management. J Bone Joint Surg Am. 1984;66:209–214. doi: 10.2106/00004623-198466020-00007. - DOI - PubMed
    1. Bowes J, Buckley R. Fifth metatarsal fractures and current treatment. World J Orthop. 2016;7:793–800. doi: 10.5312/wjo.v7.i12.793. - DOI - PMC - PubMed
    1. Chuckpaiwong B, Cook C, Pietrobon R, Nunley JA. Second metatarsal stress fracture in sport: comparative risk factors between proximal and non-proximal locations. Br J Sports Med. 2007;41:510–514. doi: 10.1136/bjsm.2006.033571. - DOI - PMC - PubMed